Medications are beneficial for curing or managing acute and chronic illnesses. Medications typically have positive outcomes, although older people are prone to drug-related problems. Community-dwelling seniors are at ...Medications are beneficial for curing or managing acute and chronic illnesses. Medications typically have positive outcomes, although older people are prone to drug-related problems. Community-dwelling seniors are at particularly high risk of polypharmacy, as they tend to receive many prescriptions over time and from different care providers. Continuing-care facility admission presents an excellent opportunity for a comprehensive medication review. A research study was conducted to describe and compare medications taken by community-dwelling seniors prior to and following admission to a continuing-care facility. This pilot project involved data being gathered from the charts of deceased residents, as required by a University Health Research Ethics Board, who had been cared for at one large local continuing-care facility. The facility administrators also approved this study, in part to evaluate their policy to conduct a medication review for all new residents within six weeks of entry. This study revealed a slight but statistically significant reduction in the number of medications following this review. Other issues such as medication interactions and required dosage changes were addressed by this medication review. Although this study was confined to one continuing-care facility and a small number of residents, the findings suggest medication reviews would be beneficial upon admission to all continuing-care facilities, and annually perhaps through other means for older persons living in the community.展开更多
“Let them eat cake”： a retrospective service evaluation of Focus on Undernutrition in care homes. Introduction： Undernutrition is a major cause and consequence of poor health in older people, affecting 35% of res...“Let them eat cake”： a retrospective service evaluation of Focus on Undernutrition in care homes. Introduction： Undernutrition is a major cause and consequence of poor health in older people, affecting 35% of residents in care homes. Focus on Undernutrition （FoU）, a dietetic service delivered by dietetic assistants uses a multifaceted approach to undernutrition management. This study aims to evaluate FoU’s impact on undernutrition outcome measures in care homes; including FoU’s influence on weight change in residents “at risk” of undernutrition, and prevalence of undernutrition and pressure ulcers （PU）. Methods： A retrospective pragmatic service evaluation was undertaken using pseudonymised data collected over 13 years on weight, undernutrition risk and PU from long-stay residents’ notes before and six months after training （FoU）. Results： Analysis completed on 104 homes, 4,315 residents （71.3% female; mean stay 10.8 （1-278） months） in County Durham. Following FoU a significant difference was identified for： improved rate of weight change for “at risk” residents （p 〈 0.001）. Undernutrition risk significantly influenced weight change （low： B1.04 kg, E0.01 kg; moderate： B-1.79 kg, E-0.38 kg; high： B-0.83kg, E1.00 kg, Bp 〈 0.001, Ep = 0.001）. Reduced undernutrition prevalence （p 〈 0.001） from 32.7% to 29.1% residents “at risk” of undernutrition （moderate： B13.1%, E8.9%; high： B19.6%, E15.9%）. Nutrition screening significantly improved （B76.3%, E98.7%, p 〈 0.001）, reduced prevalence PU （51%, p 〈 0.001）. PU prevalence significantly increased with undernutrition severity at baseline （p 〈 0.001）, but not following FoU （p = 0.233） （low： B5%, E2.3%; moderate： B6.9%, E1.6%; high： B10.5%, E3.9%）. Odds of developing PU reduced 53% （OR： 0.47）. B：baseline; E：evaluation; OR： odds ratio. Conclusion： These results demonstrate dietetic assistants delivering FoU significantly improves weight, undernutrition and PU prevalence in care homes. Indicating FoU is an effective model for improving undernutrition outcomes, with the potential of reducing possible harm, such as PU in care homes.展开更多
Despite many attempts to evaluate the effectiveness of case management for frail older people, systematic reviews including experimental designs show inconsistent results. Starting from the view that case management i...Despite many attempts to evaluate the effectiveness of case management for frail older people, systematic reviews including experimental designs show inconsistent results. Starting from the view that case management is a complex intervention occurring in multilayered realities, we conducted a realist evaluation of case management in Belgium, where this type of intervention is new. Realist approaches are particularly well suited to evaluate complex interventions as they seek to investigate iteratively the literature and empirical data to uncover mid-range theories underpinning the intervention under study. As such, realist evaluations are works in progress which provide tools to describe how, why and for whom an intervention is supposed to work. In this paper, we describe two mid-range theories that can explain why case management can help frail older people to remain at home, through the lens of capacity and social support.展开更多
Background: In situations of care transfer of older people from hospital to home care at discharge, exchanging relevant and necessary information about the patient’s health status and individual needs are of importan...Background: In situations of care transfer of older people from hospital to home care at discharge, exchanging relevant and necessary information about the patient’s health status and individual needs are of importance to ensure continuity and appropriate nursing follow-up care. Objective: The objectives of the study were to: 1) examine the content of nurses’ discharge notes of older patients’ discharged from hospital to home care, and 2) investigate the association between the content of discharge notes and characteristics of patient and transfer. Methods: The nursing discharge notes of 70 older patients admitted to a geriatric unit and a general medicine ward at a local hospital in central Norway were analysed. The discharge notes were structured in accordance with the Well-being, Integrity, Prevention, and Safety (VIPS) model. Mean, standard deviations, and independent sample t-tests were performed to show and examine differences in use of VIPS keywords in relation to patient and transfer characteristics. To examine if use of VIPS keywords could be predicted by patient and transfer characteristics, linear multiple regression analyses were used. Results: Significant differences for mean scores on used VIPS keywords in the discharge note were found for gender, age, and medical department facility. While gender and medical department facility were significant predictors of mental related keywords in the discharge note, medical department facility was a significant predictor of physical related keywords. Conclusions: The result of this study indicate that documentation of patient status in the nursing discharge note of older patients transferred from hospital to home care is incomplete and are influenced by patient and transfer characteristics. In order to ensure continuity and appropriate nursing follow-up care, we emphasize the need for a more comprehensive approach to older patients, and that this must be reflected in the nursing discharge note.展开更多
文摘Medications are beneficial for curing or managing acute and chronic illnesses. Medications typically have positive outcomes, although older people are prone to drug-related problems. Community-dwelling seniors are at particularly high risk of polypharmacy, as they tend to receive many prescriptions over time and from different care providers. Continuing-care facility admission presents an excellent opportunity for a comprehensive medication review. A research study was conducted to describe and compare medications taken by community-dwelling seniors prior to and following admission to a continuing-care facility. This pilot project involved data being gathered from the charts of deceased residents, as required by a University Health Research Ethics Board, who had been cared for at one large local continuing-care facility. The facility administrators also approved this study, in part to evaluate their policy to conduct a medication review for all new residents within six weeks of entry. This study revealed a slight but statistically significant reduction in the number of medications following this review. Other issues such as medication interactions and required dosage changes were addressed by this medication review. Although this study was confined to one continuing-care facility and a small number of residents, the findings suggest medication reviews would be beneficial upon admission to all continuing-care facilities, and annually perhaps through other means for older persons living in the community.
文摘“Let them eat cake”： a retrospective service evaluation of Focus on Undernutrition in care homes. Introduction： Undernutrition is a major cause and consequence of poor health in older people, affecting 35% of residents in care homes. Focus on Undernutrition （FoU）, a dietetic service delivered by dietetic assistants uses a multifaceted approach to undernutrition management. This study aims to evaluate FoU’s impact on undernutrition outcome measures in care homes; including FoU’s influence on weight change in residents “at risk” of undernutrition, and prevalence of undernutrition and pressure ulcers （PU）. Methods： A retrospective pragmatic service evaluation was undertaken using pseudonymised data collected over 13 years on weight, undernutrition risk and PU from long-stay residents’ notes before and six months after training （FoU）. Results： Analysis completed on 104 homes, 4,315 residents （71.3% female; mean stay 10.8 （1-278） months） in County Durham. Following FoU a significant difference was identified for： improved rate of weight change for “at risk” residents （p 〈 0.001）. Undernutrition risk significantly influenced weight change （low： B1.04 kg, E0.01 kg; moderate： B-1.79 kg, E-0.38 kg; high： B-0.83kg, E1.00 kg, Bp 〈 0.001, Ep = 0.001）. Reduced undernutrition prevalence （p 〈 0.001） from 32.7% to 29.1% residents “at risk” of undernutrition （moderate： B13.1%, E8.9%; high： B19.6%, E15.9%）. Nutrition screening significantly improved （B76.3%, E98.7%, p 〈 0.001）, reduced prevalence PU （51%, p 〈 0.001）. PU prevalence significantly increased with undernutrition severity at baseline （p 〈 0.001）, but not following FoU （p = 0.233） （low： B5%, E2.3%; moderate： B6.9%, E1.6%; high： B10.5%, E3.9%）. Odds of developing PU reduced 53% （OR： 0.47）. B：baseline; E：evaluation; OR： odds ratio. Conclusion： These results demonstrate dietetic assistants delivering FoU significantly improves weight, undernutrition and PU prevalence in care homes. Indicating FoU is an effective model for improving undernutrition outcomes, with the potential of reducing possible harm, such as PU in care homes.
文摘Despite many attempts to evaluate the effectiveness of case management for frail older people, systematic reviews including experimental designs show inconsistent results. Starting from the view that case management is a complex intervention occurring in multilayered realities, we conducted a realist evaluation of case management in Belgium, where this type of intervention is new. Realist approaches are particularly well suited to evaluate complex interventions as they seek to investigate iteratively the literature and empirical data to uncover mid-range theories underpinning the intervention under study. As such, realist evaluations are works in progress which provide tools to describe how, why and for whom an intervention is supposed to work. In this paper, we describe two mid-range theories that can explain why case management can help frail older people to remain at home, through the lens of capacity and social support.
文摘Background: In situations of care transfer of older people from hospital to home care at discharge, exchanging relevant and necessary information about the patient’s health status and individual needs are of importance to ensure continuity and appropriate nursing follow-up care. Objective: The objectives of the study were to: 1) examine the content of nurses’ discharge notes of older patients’ discharged from hospital to home care, and 2) investigate the association between the content of discharge notes and characteristics of patient and transfer. Methods: The nursing discharge notes of 70 older patients admitted to a geriatric unit and a general medicine ward at a local hospital in central Norway were analysed. The discharge notes were structured in accordance with the Well-being, Integrity, Prevention, and Safety (VIPS) model. Mean, standard deviations, and independent sample t-tests were performed to show and examine differences in use of VIPS keywords in relation to patient and transfer characteristics. To examine if use of VIPS keywords could be predicted by patient and transfer characteristics, linear multiple regression analyses were used. Results: Significant differences for mean scores on used VIPS keywords in the discharge note were found for gender, age, and medical department facility. While gender and medical department facility were significant predictors of mental related keywords in the discharge note, medical department facility was a significant predictor of physical related keywords. Conclusions: The result of this study indicate that documentation of patient status in the nursing discharge note of older patients transferred from hospital to home care is incomplete and are influenced by patient and transfer characteristics. In order to ensure continuity and appropriate nursing follow-up care, we emphasize the need for a more comprehensive approach to older patients, and that this must be reflected in the nursing discharge note.
